Investigators from Children’s Health Institute (CHI) at Temple Street, Dublin, Ireland, and the University of Birmingham, Birmingham, UK, conducted a retrospective study to estimate the prevalence of coexisting bacterial meningitis in young children with E. coli urinary tract infection (UTI). Study participants were children 8 days to 2 years old, seen at CHI at Temple Street between 2014 and 2019, with a pure growth of E. coli from a urine sample, irrespective of sample type. Cases of co-existing E. coli bacteremia in patients with UTI were were identified. Data, including culture results and white cell counts (WCC) in all cerebrospinal fluid (CSF) samples obtained within 48 hours of the time that a urine sample was collected in a child with an E. coli UTI were analyzed. Patients were classified as having bacterial meningitis if they had a positive culture or PCR result. During the study period, E. coli PCR analysis was routinely performed at CHI at Temple Street on CSF samples with pleocytosis, defined as a WCC >20 × 106 cells/L for children 7-28 days old and >10 × 106 cells/L in those >28 days old with E. coli isolated from another site; PCR analysis was deferred if there was insufficient CSF volume or the sample was overly bloody. The overall prevalence of bacterial meningitis in patients with E. coli UTI and among children 8-28 days, 1-6 months, and 6 months to 2 years was calculated.
A total of 2,174 episodes of E. coli UTI were identified in 1,903 children. Urine collection techniques included clean catch in 1,050 (48%) cases, bag specimens in 216 (10%), and mid-stream collection in 195 (9%). Among the study patients, 129 (6%) were 8-28 days old, 773 (35.5%) were 1-6 months old, and 1,272 (58.5%) were 6 months to 2 years old. Of the 2,174 episodes of UTI, 24 (1%) were associated with E. coli bacteremia. There were 314 (14.4%) CSF samples obtained within 48 hours of the time of urine collection in children with E. coli UTI. There were no positive CSF cultures. Pleocytosis was present in 71 (23%) of CSF samples, and E. coli PCR analysis was performed on 57 (80%) of these; all PCR analyses were negative. The overall prevalence of bacterial meningitis in children 8 days to 2 years old with E. coli UTI was estimated as 0% (95% confidence interval [CI], 0%, 1.1%), including 0% (95% CI, 0%, 5.3%) for those 8-28 days old, 0% (95% CI, 0%, 1.6%) in those 1-6 months old, and 0% (95% CI, 0%, 16.8%) in children 6 months to 2 years old.
The authors conclude that the risk of bacterial meningitis in young children with E. coli UTI is low.
Dr Brady has disclosed no financial relationship relevant to this...